手术治疗先天性脊柱侧凸的进展

Progress of Surgery on the Congenital Scoliosis

先天性脊柱侧凸(CS)手术成功的关键是在合适的时间选择个性化的手术方案,制定周密计划。手术方式和疗效决定于患儿年龄、早期诊断和畸形的本身特点。手术的最终目的是获得脊柱平衡,防止侧凸进展,减少神经并发症的发生,在侧凸失代偿前最大程度地矫正侧凸,并尽量缩短矫形融合范围。对无畸形或只有轻度畸形的进展性CS可采用原位融合或凸侧骨骺阻滞术;中等程度的CS可通过内固定矫形融合术获得矫正,但严重CS需联合相应的截骨或椎体切除术;对年龄<5岁、不伴肋骨融合的CS患儿来说,生长棒技术是一种可行的选择;对伴肋骨融合和胸廓功能不全的患儿来说,胸廓扩大成形和VEPTR术是一种有希望的治疗手段,对于严重僵硬性的成人和年长的儿童的CS应用后路脊椎截骨术。

The key to successful surgery on congenital scoliosis was to choose an optimal strategy,and to make a detail plan in terms of the patient＇ s status. It was up to the patient＇ s age, early diagnose and the characteristics of curve with regard to the method and effect of surgery. The aim to correction was to obtain the balance of spine,to prevent the progress of deformity, to de- crease the incidence of complication of neurological deficit, to correct the deformity at best before the decompensation of deformity ,and to diminish the extent of spondylodesis. Fusion in situ and/or epiphyseal arrest in the convexity of curve were performed in the progressive CS with no abnormalities or mild deformity, instrumentation with moderate deformity, and hemivertebrae removal or osteotomy with severe deformity. Growing rod technology in CS were adopted by the children with age below 5 years old without fusedrib,and expansion thoracoplasty and vertical expandable prosthetic titanium rib （VEPTR） was fit for children CS with fusedrib and chest insufficiency. Posterior osteotomy was properly a best chose for adult CS and.elder children CS.